摘要
目的分析上肢高选择性周围神经切断术联合术后早期康复干预对脑卒中后痉挛性偏瘫患者运动功能的影响。方法选取2023年1至12月收治的62例脑卒中后痉挛性偏瘫患者。根据随机数字表法分为观察组和对照组31例,对照组予以常规康复治疗措施,观察组行上肢高选择性周围神经切断术联合术后早期康复治疗。比较两组临床疗效及复发情况、改良Ashworth痉挛评定量表(MAS)、医学研究委员会量表(MRC)肌力分级、Fugl-Meyer评定量表(FMA)评分、改良Barthel指数评定量表(MBI)评分、脑卒中影响量表(SIS)评分及并发症。结果研究期间观察组脱落2例,故评估结果以29例进行分析。术后1、3、6个月及术后1年,观察组上肢FMA、MBI、SIS评分均高于对照组(P<0.05);术后6个月及术后1年观察组MAS分级、MRC肌力分级改善情况均优于对照组(P<0.05;P<0.01);术后1年观察组治疗总有效率[100.00%(29/29)]高于对照组[80.65%(25/31)](P<0.05);两组并发症发生率及1年内复发率比较差异无统计学意义(P>0.05)。结论脑卒中后痉挛性偏瘫患者应用上肢高选择性周围神经切断术联合术后早期康复干预方案效果确切,可有效改善痉挛程度,降低肌张力,提高上肢运动能力。
Objective To analyze the effect of upper limb selective peripheral neurotomy combined with early postoperative rehabilitation on motor function in patients with post-stroke spastic hemiplegia.Methods A total of 62 patients with post-stroke spastic hemiplegia admitted from January to December in 2023 were selected.According to the random number table method,they were divided into the observation group and the control group with 31 patients in each group.The control group was given conventional rehabilitation treatment,while the observation group was treated with upper-limb highly selective peripheral neurotomy combined with early postoperative rehabilitation.The clinical efficacy and recurrence,modified Ashworth spasm rating scale(MAS),medical research council(MRC)scale for muscle strength grading,Fugl-Meyer assessment scale(FMA)score,modified Barthel index rating scale(MBI)score,stroke impact scale(SIS)score and complications were compared between the two groups.Results During the study period,2 patients were lost in the observation group,so the evaluation results were analyzed in 29 patients.The scores of upper limb FMA,MBI and SIS in the observation group were higher than those in the control group at 1,3,and 6 months and at 1 year after operation(P<0.05).The improvement of MAS gradiing and MRC scale for muscle strength grading in the observation group was better than that in the control group at 6 months and 1 year after operation(P<0.05,P<0.01).At 1 year after operation,the total effective rate of the observation group[100.00%(29/29)]was higher than that of the control group[80.65%(25/31)](P<0.05).There was no significant difference in the incidence of complications and recurrence rate within 1 year between the two groups(P>0.05).Conclusion Upper-limb highly selective peripheral neurotomy combined with early postoperative rehabilitation intervention is effective in patients with post-stroke spastic hemiplegia,which can effectively ameliorate the severity of spasm,reduce muscle tension and improve upper limb motor ability.
作者
徐健锟
刘德清
蔡诚凤
伍翰笙
贺中正
XU Jiankun;LIU Deqing;CAI Chengfeng;WU Hansheng;HE Zhongzheng(Department of Hand and Foot Surgery and Rehabilitation,Guangdong Work Injury Rehabilitation Hospital,Guangzhou 510000,China;Department of Neurosurgery,Huanhu Hospital Affiliated to Tianjin Medical University,Tianjin 300350,China)
出处
《临床误诊误治》
2025年第24期32-40,共9页
Clinical Misdiagnosis & Mistherapy
基金
广东省医学科学技术研究基金项目(B2023196)。
关键词
脑卒中
痉挛性偏瘫
高选择性周围神经切断术
术后康复
肌张力
运动功能
复发
stroke
spastic hemiplegia
highly selective peripheral neurotomy
postoperative rehabilitation
muscle tension
motor function
recurrence
